血栓弹力图在妊娠合并血小板减少症患者中的应用

目的探讨血栓弹力图(thromboelastography,TEG)在妊娠合并血小板减少症患者(PAT)中的应用。方法收集我院2016年4月～2019年3月确诊的60例妊娠合并血小板减少症患者,按照1∶1比例配对法分为两组,对照组30例,行常规凝血功能检测;观察组30例,进行常规凝血功能检测及血栓弹力图检测评估,分析两组的分娩情况、术中术后出血情况及实验室指标检测结果。结果两组ALT、AST、PT、APTT、TT、FIB无明显差异(P0.05),观察组阴道分娩率高于对照组、术中出血量高于对照组(P0.05),但两组的术后出血量及产后大出血发生率无差异(P0.05)。结论血栓弹力图用于PAT患者凝血的监测,可评估出血风险,为分娩方式的选择提供指导依据。     

肝移植患者凝血功能和血栓弹力图指标动态变化*

目的 研究肝移植患者血栓弹力图(TEG)和凝血功能指标的变化及其对输血的指导意义。方法 2018年3月～2020年3月在我院治疗的52例肝移植患者,比较无肝前期、无肝期和新肝期输血和未输血患者TEG指标,如反应时间(R)、血块形成时间(K)、角度(α)、最大振幅(MA)和凝血功能指标,如凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)和纤维蛋白原(Fib)的变化。结果 在52例患者中,无肝前期输血率为17.3%,无肝期输血率为86.5%,新肝期输血率为75.0%(P<0.05);无肝前期输血患者APTT为(74.4±7.2)s,显著长于未输血患者【(66.9±8.1)s,P<0.05】,新肝期输血患者PT和TT分别为(30.4±5.4)s和(30.2±3.6)s,显著长于未输血患者【分别为(26.1±4.6)s和(27.0±4.2)s,P<0.05】,无肝期输血与未输血患者APTT、PT、TT和Fib水平无显著性差异(P>0.05);无肝前期输血患者K值为(7.6±1.8)min,显著长于未输血者【(6.0±2.0)min,P<0.05】,无肝期输血患者R、K和α分别为(26.4±5.5)min、(15.3±2.8)min和(15.8±4.4)°,未输血者分别为(21.8±4.3)min、(12.0±3.9)min和(19.5±3.9)°,两组间差异均有统计学意义(P<0.05);新肝期输血患者α和MA分别为(20.3±4.1)°和(34.4±5.8)mm,未输血者分别为(23.8±3.5)°和(39.0±4.5)mm,两组间差异有统计学意义(P<0.05);无肝前期20例大量输血患者APTT为(77.3±6.8)s,显著长于32例未大量输血患者的【(70.4±7.9)s,P<0.05】,无肝前期大量输血患者K值为(8.0±1.7)min,显著长于未大量输血患者【(7.1±1.4)min,P<0.05】,无肝期大量输血患者R值为(29.3±5.2)min,显著长于未大量输血患者【(23.6±4.7)min,P<0.05】,无肝期大量输血患者K值为(16.8±3.1)min,显著长于未大量输血患者【(13.7±2.8)min,P<0.05】,无肝期α为(15.2±3.6)°,显著小于未大量输血患者【(18.4±4.4)°,P<0.05】,新肝期大量输血患者TT水平为(31.5±3.0)s,显著长于未大量输血患者【(28.2±3.3)s,P<0.05】,新肝期大量输血患者MA水平为(32.8±5.5)mm,显著短于未大量输血患者【(38.7±4.3)mm,P<0.05】,新肝期大量输血患者α为(19.8±3.7)°,显著小于未大量输血患者【(22.4±3.1)°,P<0.05】。结论 对于肝移植患者及时动态地监测TEG和凝血功能指标有助于判断凝血功能变化,指导合理地输血,各指标的意义还需要认真地研究。     

Hot topics in coagulation testing: Important considerations for testing children for bleeding/thrombotic disorders

The accurate use and interpretation of diagnostic investigations are essential for safe and effective patient care. Appropriate application and interpretation of coagulation testing can be challenging, and many controversies exist relating to the standardization of testing procedures, the application of relevant tests to different patient populations and the interpretation of test results. We present a list of the most prominent controversies in coagulation testing and have selected three specific examples (age‐appropriate reference ranges, therapeutic anticoagulation monitoring and tests of thrombin generation) for closer discussion, highlighting examples with a paediatric framework. We discuss the limitations of discrete age‐partitioned reference intervals, given the established principle of developmental haemostasis; the difficulties in establishing normative data across different laboratories; important pre‐analytical variables affecting coagulation testing; the challenges in interpreting APTT and anti‐Xa assays for monitoring unfractionated heparin therapy in different clinical situations; and the limitations in interpreting tests of thrombin generation due to current available thrombin‐specific substrates and the complicating factor of variable alpha2‐macroglobulin levels. These controversies are demonstrated using paediatric examples, but raise important implications for coagulation testing in patients of all ages and highlight the pressing need for further research in these areas.     

丹参注射液对失代偿期肝硬化患者凝血功能的影响

目的:评价丹参注射液对失代偿期肝硬化患者凝血功能的影响.方法:失代偿期肝硬化患者40例随机平均分为丹参治疗组和对照组,前者在综合治疗的基础上加用丹参注射液治疗,治疗前及治疗后2wk测定凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)等凝血功能指标,并观察两组治疗期间临床出血情况.结果:治疗前对照组和丹参组PT,APTT,TT和FIB测定值分别为:17.2±5.9s,50.3±5.1s,21.5±2.5s,1.7±1.2g/L和17.5±5.7s,50.1±5.8s,21.3±2.7s,1.7±1.0g/L,治疗后对照组和丹参组PT,APTT,TT和FIB测定值分别为:15.8±5.0s,47.2±5.3s,19.2±2.1s,1.8±1.3g/L和14.5±4.0s,44.2±5.6s,17.2±2.4s,2.0±1.5g/L.两组治疗前后PT,APTT,TT和FIB均有显著差异(P<0.05),但丹参组比对照组对PT,APTT,TT和FIB的改善更为明显(P<0.05).丹参组治疗期间出血发生率明显低于对照组(25%vs50%,P<0.05).结论:丹参注射液能够改善失代偿期肝硬化患者的凝血功能,降低临床出血率,提示丹参注射液治疗失代偿期肝硬化是安全有效的.     

凝血因子VR2等位基因多态性在血栓相关性疾病患者中的分布

目的：通过检测血栓相关性疾病患者的凝血因子V（coagulation factorV)R2等位基因多态性，探讨R2单体型与血栓形成的相关性。方法：采用PCR-酶切法对100个脑血栓患者，96个心肌梗塞患者，45个深静脉血栓患者，80个系统性红斑狼疮患者，以及98个正常对照进行FVR2等位基因检测。结果：首次发现2例系统性红斑狼疮患者基因型为R2等位基因杂合子。结论：中国汉族人群血栓形成的遗传分子背景与FVHR2等位基因可能没有相关性。     

Comparison between siliconized evacuated glass and plastic blood collection tubes for prothrombin time and activated partial thromboplastin time assay in normal patients, patients on oral anticoagulant therapy and patients with unfractioned heparin therapy

Introduction: The study was designed to evaluate whether there was a statistically significant effect between evacuated glass tubes and plastic tubes on prothrombin time (PT) and activated partial thromboplastin time (aPTT). Methods: Blood samples were drawn into four different tubes from three patient populations—apparently healthy patients, patients on oral anticoagulant therapy with vitamin K antagonists (OAT‐vka) and patients being treated with unfractioned heparin (UFH). Testing was performed on an automated coagulation analyzer, and statistical analysis was achieved using a test of variance (anova ). Results: For normal patients, there were no statistically significant differences for the aPTT test; however, there were statistically significant differences for the PT test. For patients on OAT‐vka, statistically significant differences were clearly observed between the four tube types for the PT test. For patients treated with UFH, there were no statistically significant differences for the aPTT test. Conclusion: The data showed a statistically significant difference between glass and plastic tubes in the normal population only for the PT test, with consequent repercussions for patients on OAT. This means that appropriate care and validation should take place whenever there is a change in tube type.     

部分凝血因子与慢性重型肝炎预后关系的分析

目的研究部分凝血因子以及凝血酶原活动度（PTA）、凝血酶原时间的国际标准化比值（INR）等检测指标与慢性重型肝炎（CSH）预后的关系。方法选择2007年6月2008年1月我院收治的CSH患者31例，依据病情转归，分为存活组（17例）和死亡组（14例）。使用德国BE公司生产的Thrombolyzer Rack Rotor全自动凝血仪检测PTA、INR、凝血因子Ⅱ（FⅡ：C）、凝血因子Ⅴ（FⅤ：C）、凝血因子Ⅶ（FⅦ：C）及凝血因子Ⅹ（FⅩ：C）水平。选用SPSS软件对所得数据进行单因素和多因素判别分析，并对各生化指标进行相关性分析。结果CSH发生时存活组与死亡组FⅡ：C分别为31．1％±10．8％和20．4％±18．5％，FⅤ：C分别为39．4％±19．0％和14．3％±8．7％，FⅦ：C分别为21．9％±11．8％和6．4％±4．9％，FⅩ：C分别为57．2％±26．1％和42．2％±24．5％，存活组与死亡组PTA分别为28．0%±8．0％和13．5％±5．1％，INR分别为2．1±0．6和4．4±1．6。单因素分析显示FⅦ：C与CSH预后具有相关性（P〈0．05）；PTA、INR、FⅤ：C与CSH预后具有非常显著的相关性（P=0．00）。二分类Logistic回归分析筛选出与CSH预后相关的主要凝血指标INR和FⅤ：C，两者结合可以明显提高对CSH预后判断的阳性率（93．5％）。相关性分析显示，INR、FⅤ：C与PTA高度相关，相关系数分别为0．862、0．711。结论FⅦ：C、FⅤ：C、PTA、INR水平可作为CSH预后的判定指标，其中FⅤ：C和INR较PTA更为特异，同时测定FⅤ：C和INR水平可以更早、更准确判断CSH预后。     

Low levels of activated factor VII in systemic sclerosis

Introduction. Recent investigations show that activated factor VII, the primary enzyme in the extrinsic pathway of blood coagulation, exerts additional extra-coagulant functions, such as apoptosis and angiogenesis. On the basis of these recent acquisitions, the present study was aimed to evaluate activated factor VII in patients with systemic sclerosis and to establish a potential association with pathogenesis and complications of this severe autoimmune disorder. Materials and methods. Activated factor VII level was measured in twenty-eight consecutive scleroderma patients (2 men and 26 women, mean age 49.7 ± 14.8 years). The main clinical correlates of disease, such as disease activity, renal function, skin, vascular and lung involvement, were evaluated by clinical and instrumental investigations. Activated factor VII level was also evaluated in 28 sex and age matched controls. Results. Systemic sclerosis patients exhibited plasma activated factor VII activities significantly lower than those of healthy matched controls (15.2 versus 37.7 U/l, respectively; p < 0.001). No correlation was observed between plasma activated factor VII concentration and age, disease duration, disease subset, disease activity, renal, lung, skin and microvascular involvement. Conclusions. Results of our investigation provide first evidence of low activated factor VII activity in patients with systemic sclerosis. Reduced activated factor VII activity might be involved in the pathogenesis of the ischemic complications, by modulating apoptotic and angiogenetic processes. Contributed equally to this work.